Type 2 diabetes is the type of diabetes that is observed in adults due to insulin resistance or an inability to use existing insulin. Because of insulin resistance, the hunger sensation is not lost, and thus food consumption is higher. When obesity occurs, insulin resistance increases and this leads to the vicious cycle. Metabolic syndrome is a serious condition leading to type 2 diabetes, hypertension, obesity, cholesterol metabolism imbalance, serious damage to organs, work and power loss, cardiovascular diseases. In metabolic surgery, the part of the hormones that are related to insulin resistance are deactivated, and the levels of the hormones increasing insulin resistance are increased.
Insulin resistance hormones, such as ghrelin from the stomach fundus, GIP from the duodenum, and glucagon from the pancreas, and insulin sensitivity hormones, such as GLP-1 released from the L cells at the end of the small intestine, are secreted. GLP-1 enhances the effect of insulin and then stimulates insulin production from the pancreas. In the surgical approach, ileal interposition is performed by making the last part of the small intestine the stomach’s exit into the final part of the stomach together with tube stomach surgery. The aim of metabolic surgery is the creation of metabolic satiety both with mechanical and functional restriction.
After surgery, 95% of diabetes patients maintain their lives without the need for any vitamins and supplements. Ten-year studies show that blood glucose levels improve without medication in 85-90% of patients after surgery and 75-80% of patients lose their excess weight.
Diabetes surgery (metabolic surgery) can be applied to individuals in whom insulin resistance cannot be overcome with medical treatment, diet, and exercise lasting for a minimum of 2 years. The pancreas should maintain its ability to produce insulin. In individuals who have undergone metabolic surgery, 90% improvement occurs in other metabolic disorders, and improvement between 70-90% occurs in cardiovascular disorders, some respiratory diseases, vision disorders, knee and joint disorders, impotence, hypertension, and organ failure. Metabolic surgery (diabetes surgery) is one of the most effective methods applied in the surgical treatment of type 2 diabetes and obesity. Metabolic surgery is performed by employing a technique called laparoscopic camera (closed system). Diabetes can be caused by heredity and dietary disorder. Scientific studies have demonstrated that the possibility of developing diabetes is high in individuals having first-degree relatives with diabetes. The increased consumption of refined foods (processed foods), foods with the high glycemic index, limitation of physical activity, increased insulin resistance increase the possibility of developing this disease. The aim of metabolic surgery is to replace the last part of the small intestine using the laparoscopic camera. The length of the intestines does not change in this surgery. The aim of metabolic surgery is the formation of hormonal changes and the benefits resulting from this. The first option in obese patients is tube stomach surgery. Thus, a large part of the stomach with the ghrelin hormone, responsible for hunger, is taken. As a result of taking 75% of the stomach, gastric emptying is accelerated, the food is less digested and passes to the small intestine in a short time using the new pathway
With bipartition surgery, two-thirds of the food pass through the new pathway. The stomach, which is reduced and accelerated after tube stomach surgery, transmits the completely undigested food to the small intestine through a newly opened pathway. Thus, the secretion of the GLP-1 hormone is stimulated. GLP-1 is a hormone that increases the release and efficacy of insulin. Therefore, type 2 diabetes undergoes 90% remission. With the shrinkage of the stomach, calorie intake is restricted, and the feeling of satiety is reached quickly. Thus, nearly all of the patients lose about 80% of their excess weight in the first year. After metabolic surgery, insulin resistance, which is one of the causes of obesity and diabetes, is prevented by increasing insulin secretion and its effect.
Diabetes surgery can be applied to patients aged 17-70 years, who have not broken insulin resistance with 2 years of medical treatment, exercise, and diet. The reason for the preference of surgery is the continuation of insulin production by the pancreas, even a little. It is applied to patients with metabolic disease accompanying type 2 diabetes, with obesity, hypertension, high cholesterol, sleep apnea, joint problems, and respiratory diseases
Diabetes is not only induced by hormones but is caused by a combination of environmental factors, eating habits, psychological reasons, heredity, irregular or stagnant lifestyle. The symptoms of diabetes occur slowly. These are numbness in the hands and feet, excessive thirst and hunger, frequent urination, frequent infections, slow-healing wounds. Before diabetes surgery, in type 2 diabetes, it is attempted to keep the blood glucose level under control with medication, insulin supplements, diet and exercises which are classical treatment methods. Only 15-20% of patients break down insulin resistance and take the blood glucose level under control for a certain period of time.
Transit bipartition surgery is a very suitable treatment method for patients who live an insulin-dependent life. The side effects of medication and insulin administration used in the treatment of diabetes may impair the metabolism tired of diabetes. With diabetes surgery, 70-95% improvement is achieved in hypertension, vision disorders, impotence, discomfort in the knees and joints, some respiratory diseases, vascular and cardiac disorders, and organ failures. Type 2 diabetes may cause organ losses and paralysis/hemiplegia with the constriction of the brain vessels. Diabetes surgery is the most effective option to prevent these outcomes.
With diabetes surgery, sleeve gastrectomy and transit bipartition come together. Firstly, approximately 80% of the stomach is taken by tube stomach surgery (Sleeve Gastrectomy). In transit bipartition, the last part of the small intestine (ileum) is connected to the stomach, the volume of which has been reduced with tube stomach surgery, in a different way from the normal digestive tract.
The last part of the small intestine that directly affects the secretion of insulin is replaced. The mark is put 100 cm before the junction point of the small and large intestine. The mark is left 150 cm close to the marked area, and an incision is made into the small intestine. The lower end of the intestine is connected to the stomach with a new 2.5-3 cm pathway. The upper end is connected to the part previously marked 100 cm before the junction point of the large and small intestine. After bipartition surgery, 65% of foods pass through the new route and 35% pass through the old route. The aim here is taking and excluding the 80% part of the stomach secreting the ghrelin hormone, responsible for hunger. A sense of hunger is suppressed, and weight loss is accelerated with decreased food intake.
Changes occur in the GLP-1 hormone related to insulin secretion in the ileum of the displaced small intestine. GLP-1 triggers insulin secretion from the pancreas and increases the effect of insulin in the blood and tissue. Thus, insulin resistance, which is the most important issue in type 2 diabetes, is broken down and 90% recovery from the disease is ensured. Complete recovery is ensured in 75-90% of hypertension, obesity, sleep apnea, cardiovascular diseases, high cholesterol, discomfort in the knees and joints, respiratory diseases, and metabolic diseases accompanying type 2 diabetes. Since the food will pass in all of the intestines with diabetes surgery, there will be no mineral and vitamin deficiencies associated with absorption disorder.
Diabetes surgery lasts for approximately 3-6 hours. The average hospital stay is 4-5 days. There are 5 incisions between 0.5-2.0 cm on the abdomen. At the end of the surgery, the pain is low since the size of incisions is small. The patient can stand on the same day. The next day, the patient can start to consume water and liquid foods (soup, meat, chicken, vegetable and fruit juice). If everything is positive and there is not any complication, the patient is discharged on the 3rd-4th day.
Patient preparation before surgery is important. It is necessary to quit smoking and drinking alcohol and go on a diet rich in protein and vegetables. The time of rest at home is the process of transition from liquid food to solid food. The process lasting for an average of 3 weeks starts. One week after the surgery, sutures are removed, and daily activities can be started. After the removal of sutures, there is no obstacle to daily activities, swimming, walking, exercise, fitness, riding a bicycle and other movements that are performed without lifting the weight.
Water consumption and protein intake are essential after the surgery; if necessary, protein supplementation is applied. Dehydration is another important issue.
The stomach is reduced by the tube stomach surgery performed with diabetes surgery, and the part that secrets the hormones increasing the feeling of hunger is removed. Thus, meals are skipped with the loss of appetite.
Importance should be attached to not skipping meals. Daily consumed water and calories should be recorded. A protein and vegetable consumption program should be applied under the monitoring of a dietitian, and physical activities should be carried out. The medication and insulin doses used to control the blood glucose after diabetes surgery decrease over time and start to be used little or not used at all with the blood glucose turning to normal over time. Although the absorption of the intestines does not change with diabetes surgery, attention should be paid to mineral and vitamin deficiency with a decrease in the consumed foods, doctor follow-ups should not be neglected, the recommendations of the doctor should be strictly implemented.